经椎弓根后外侧椎管减压椎间植骨内固定治疗胸腰椎骨折

Trans-vertebral pedicle,posterolateral spinal canal decompression and interspinal bone grafting with internal fixation for treating thoracolumbar fracture

目的探讨经椎弓根后外侧入路椎管减压椎间植骨内固定治疗胸腰椎骨折的疗效。方法从2001年2月至2006年6月对23例胸腰椎骨折患者施行经椎弓根后外侧入路椎管减压,椎间植骨,椎弓根钉-棒内固定治疗。骨折块侵占椎管35%～95%,均伴有不同程度神经功能障碍,FrankeI分级,A级1例,B级2例,C级11例,D级9例。结果23例随访6～31个月,伤椎椎体高度基本恢复,Cobb角由平均21°恢复到3°未发现。植骨块和骨折的移位,脊髓神经功能A级1例无恢复外,其余均获1～2级恢复。结论经椎弓根后外侧椎管减压,椎间植骨,椎弓根钌-棒内固定治疗胸腰椎骨折可达有效减压,脊柱稳定性好,特别适宜于严重的下腰椎骨折和多节段腰椎骨折患者。

Objective To investigate the lateral spinal canal decompression and interspinal curativ effects bone grafting on transvertebral pedicle, with internal fixation for postero treating thoracolumbar fracture. Methods From February 2001 to June 2006,23 cases with thoraco-lumbar fracture underwent trans-vertebral pedicle,posterolateral spinal canal decompression and interspinal bone grafting with internal fixation by vertebral pedicle nail-clavate system were analyzed retrospectively. The spinal canal was invaded to 35-95% by bone fracture piece. All cases had dysneuria of different degree. According to Frankel grading, grade A, B, C and D were 1,2,11 and 9 cases respectively. Results 23 cases were follow-up from 6-31 months. Height of wounded vertebral body was restored essentially. Cobb angle was restored from 21~ to 3~. Except for 1 case of grade A of spinal cord function was no restored, the others were got to restore 1 to 2 grade. Conclusion This surgical procedure possesses effective decompression and keeping good spinal stability for treatment of thoracolumbar fracture, especially in the case of severe low lumbar fracture and multiple lumbar fracture.